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AGING GRACEFULLY WITH AYURVEDA By: Mori Leshem

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INTRODUCTION

In Ayurveda, the transition into menopause is identified as the shift into the Vata phase of life. It

is associated with wisdom, the ability to reach higher levels of spirituality and a time to revel in

the accomplishments of one’s life in their earlier years. In contrast, the notion of menopause in

the West is well captured in the famous movie Sex and the City, where the vivacious character

Samantha begins this transition while on vacation with her friends. She experiences hot

flashes, fear of losing her sex appeal and beauty, and anxiety regarding what she believes to be

the impending demise of her femininity due to menopause. This paper will discuss the

inevitable female passage into menopause and demonstrate how women can better prepare for

and manage the discomforts of the transition using ancient Ayurvedic wisdom.

The Western definition of Menopause, according to a World Health Organization paper, is the

“permanent cessation of menstruation…This period is characterized endocrinologically by

evidence of decreasing ovarian activity, biologically by decreasing fertility, and clinically by

alterations in menstrual cycle intervals and by a variety of symptoms.”1 In the Ashtana

Hrdayam, it is said “Just as the lotus closes at the end of the day, so also the yoni after the rtu

kala (the period suitable for conception); thereafter she will not be receptive for sukra (seman).”2

Yoni is the Sanskrit work for vagina. The two aforementioned definitions are similar. Both

characterize menopause as a time when a woman is no longer able to conceive. The Western

definition elaborates that it is due to a decrease in ovarian activity and a change in the

menstrual cycle.

If all women go through menopause, then why is menopause such a big topic of conversation?

Why do women fear it? In her book, Balance Your Hormones, Balance, Your Life, Dr. Claudia

Welch says “Menopause is a natural passage in life, yet it is also the Great Unveiler. Whatever

maladies were lurking under the surface before menopause will be revealed…It’s a time when

either we refuse to change what is problematic in our diets and lifestyles and thus lurking

maladies grow bigger, or we make those long-awaited changes and the maladies resolve.”3

The maladies Dr. Welch refers to are the reason women fear menopause. They are the

uncomfortable symptoms associated with this time of life such as hot flashes, insomnia, anxiety,

weight gain, palpitations, depression, dryness and pain during intercourse, osteoporosis, among

others. According to Welch and eastern theory, it is not menopause itself that brings discomfort

to women. It is underlying imbalances that accumulated and were not corrected earlier in life.

These imbalances are magnified and present strongly during the hormonal decline called

perimenopause, which terminates with the final cessation of menstruation called menopause.

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The age of menopausal onset (perimenopause) differs from one woman to the next and also

has wide variability based on where one lives in the world. Studies of women in different

countries showed the average age varied by about 5-6 years, with low-income countries

showing an earlier onset. The median age is 48 in Ghana, 49 years in Lebanon and Latin

America, 50 years in Iran and 51 years in the United States, United kingdom and Greece.4

Although menopausal symptoms vary, “women around the world suffer from ailments

characteristic of the menopausal period regardless of ethnic origin, skin color or socio-

demographic factors.”5 With this in mind, managing diet and lifestyle in the years prior to the

onset of perimenopause can result in a smoother transition into this phase of life.

While the typical age for onset of menopause is 50-51 years of age in the United States6, early

onset is possible. Early menopause, “before age 40 is called premature menopause or

premature ovarian failure. This occurs in 1% of women for a variety of reasons…Menopause

can also be induced by surgery or radiation, which destroys the uterus. This condition is called

artificial menopause.”7 This paper will focus on the more typical cause (aging), as well as the

manifestation and treatment of traditional menopause.

WESTERN DEFNITION AND PATHOLOGY

In an article on Menopause by OlaOlurun and Shen, Menopause is defined as the “permanent

cessation of menses, and it occurs at the end of the menopausal transition, also referred to as

the perimenopause. The perimenopause is a period usually characterized by an irregular

menstrual cycle and hormonal fluctuations often associated with unpleasant and uncomfortable

symptoms and signs. The diagnosis of menopause is made retrospectively after a woman’s

menses have ceased for 12 consecutive months.”8 It is valuable to note that menopause is

defined as the official end of menstruation. Perimenopause is the timeframe during which many

of the uncomfortable symptoms associated with menopause begin. This transition period can

last between 2 and 8 years.9 Remedies aim to provide relief from symptoms and discomforts,

as well as long term deterioration of health.

During the reproductive years, a healthy menstrual cycle begins with a drop in estrogen and

progesterone. This triggers the release of the hormone FSH, leading to a gradual increase in

estrogen, followed by a spike in the hormone LH which results in ovulation. This is followed by

a decrease in these same hormones (FSH and LH), a small increase in estrogen until estrogen

declines if there is no conception. At this point menstruation begins again and FSH rises again.

Thereafter, the hormonal cycle repeats itself again.

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In contrast, perimenopause and menopause are characterized by changes in the hormones

secreted during the menstrual cycle. Physiologically, the number of ovarian follicles decline.

The remaining follicles are unable to respond to FSH. This results in a lack of an LH surge and

the absence of ovulation. Simultaneously, estrogen production declines and menstruation is

inconsistent. FSH and LH levels remain high and estrogen declines.10 These changes lead to

inconsistent menstruation and a rapid decline in estrogen.

In the absence of the tissue building and stabilizing benefits of estrogen, women experience a

variety of symptoms of depletion. The below chart gives a snapshot of the many possible

ailments of perimenopause and menopause:

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Clearly the number of possible symptoms associated with menopause are high. These include

mental, sexual, urogenital, musculoskeletal, metabolic, skin, hair, and mucosal depletion or

changes. The changes may affect almost every tissue of the body. It has been noted that 75%

of women experience hot flashes during the perimenopausal period.12 Furthermore,

“osteoporosis is most prevalent in women over the age of 50…osteoarthritis is extremely

common by age 70. Almost all persons by age 40 have some pathologic change in weight

bearing joint.”13 Another study found that “patients with menopausal symptoms were more likely

to have depression and anxiety and incurred significantly higher follow up healthcare costs.”14

This timeframe in a woman’s life comes with many changes both physically and mentally. But is

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estrogen decline the primary and only culprit of all menopausal distress? According to Ayurveda

there is more to this story. Hence, we discuss the Ayurvedic outlook on menopause.

THE AYURVEDIC PATHOLOGY OF MENOPAUSE

Similar to Western theory, the ancient Ayurvedic texts point to “Rojonvritti (menopause)

occurring in Jarapaka Shareer (aged body) at the age of 50 years.15 However, the ancient texts

painted a different picture with respect to menopause. This timeframe in life was described as

“Nishpratikriya (changes cannot be resisted) and Swabhavabal Roga (natural disease).16

Ayurveda views menopause as a natural transition in life. It is the transition from the pitta time

of life to the Vata time of life. Just as children transition from crawling to walking and later from

the kapha time of life (adolescence) to the pitta time of life (known to us in modern day as

puberty), so too do adults advance into the final timeframe which is the Vata stage of life.

In the Vata time of life, the body will experience more qualities of Vata dosha. Vata is made up

of the air and ether elements. It is characterized by the qualities (gunas) of light, dry, cold,

rough, subtle and mobile. When balanced, Vata is “creative, imaginative, vivacious and

outgoing.”17 Furthermore, “Vata governs all movement in the body – It is for this reason that

Vata is known as the ‘King of doshas’. Vata is responsible for our breathing, blinking of our

eyes, beating of our hearts, the activities of the nervous system and the process of elimination.

In the mind Vata governs the movement of thought.”18 Vata dosha plays a critical role in our

overall physical and mental well-being when in balance. It can support creative endeavors and

emotional fulfillment in the later years of life.

In Dr. Marc Halpern’s book, Clinical Ayurvedic Medicine, he says that menopause is a time in

life that women can go deeper into spirituality as they move away from their reproductive years

and responsibilities.19 This demonstrates Ayurveda’s positive outlook on the menopausal years

of life. Women have less responsibility for others and more time to focus on themselves and

their inner/spiritual growth.

Halpern goes on to say “most imbalances related to menopause are imbalances of Vata.20

Imbalanced Vata has the ability to wreak havoc on the body and mind. Ayurvedically, it is not

menopause that is the “disease” or “problem” during the later years of life. It is an imbalance in

the doshas, primarily Vata, that leads to uncomfortable symptoms.21 In fact, the Astanga

Hrdayam states that “without the aggravation of Vata, the vagina does not get disordered in

women, hence it should be treated before Pitta and Kapha.22 Knowing this, one can feel

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empowered that relief from symptoms is possible through Ayurvedic tools for balancing the

doshas.

The chart below gives a comprehensive view of why women experience certain ailments during menopause from an Ayurvedic lens.

Stage  Evidence   Dosha  Subdosha  Dhatu  Srotas 

RMD  Vaginal dryness  Vata  Vyana  rasa  Artavavaha 

RMD  Atropic vaginitis  Vata  Udana  mamsa  Artavavaha 

RMD 

Emotional instability, insomnia, irritability, 

anxiety  Vata Prana, vyana, 

samana  N/A  Manovaha 

RMD  Hot flashes  Vata  Samana  N/A  Annavaha 

RMD  Cystitis  Vata  vyana  Rasa   Mutravaha 

RMD  Incontinence   Vata  Udana  Mamsa  Mutravaha 

RMD  Palpitations/tachycardia  Vata  Vyana  Rasa  Rasavaha 

RMD  Osteopenia/osteoporosis  Vata  Apana  Asthi  Asthivaha 

RMD  Endocrine imbalance until ovaries stop producing ova   Vata  N/A  Shukra  Artavavaha 

This chart assumes an understanding of Ayurvedic theory. However, one can see from looking

at the dosha column that the majority of symptoms stem from an imbalance in Vata dosha.

According to the Sushrtua Samhita, “Vata has been considered as responsible for all the good

and bad in the body, doer of all the actions, soul of all the things, possessor of all forms, chief of

all living being, creator, supporter and controller of all, omniscient, destroyer, lord of death and

death itself.”23 Vata is frequently the root of destruction of bodily tissues. Its light, rough and

cold qualities deplete. We can see its impact on bodily tissues in the above chart as follows:

Depletion or destruction of bone tissue resulting in osteoporosis and hair loss.

Reduction of internal hydration and warmth that leads to constipation.

Anxiety and worry (the inability of the mind to manage and digest thoughts properly).

This results from Vata’s mobile qualities that creates an overactive mind.

Depleted rasa dhatu (hydration in the reproductive organs) leading to vaginal dryness.

This dryness leads to friction and can transform into cystitis in the urinary system.

Degraded muscle tissue can progress into atropic vaginitis and incontinence.

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Even when Vata dosha is not the final force creating imbalance, it is the driving force that blocks

or pushes the other doshas out of balance.

Frequent anger is a common symptom for some women during menopause. This is a

manifestation of aggravated Pitta dosha. Pitta dosha is made up of fire and a little water. It is

the primary dosha in the middle part of life (from puberty through menopause). It is responsible

for digestion and metabolism. It drives intensity, focus, digestion of information and sharpness

of the mind. In the case of menopause, the mobile quality of vata dosha fans the so-called

flames of pitta fire causing more intensity and anger. This happens when pitta dosha has not

been properly managed in the years and decades prior to menopause. Dr. Claudia Welch says

that “Estrogen deficiency may simply be due to a long-term excess of stress hormones.”24

Welch’s approach coincides with the Western notion that estrogen decline during menopause.

However, she expands further that stress is the precursor underlying the depletion of estrogen.

Ayurvedically, stress is most often a Vata and/or Pitta trait. This gives us additional tools for

understanding lifestyle factors that need to be a focus of health management in the years and

even decades leading up to and during menopause.

Another frequent symptom of menopause is weight gain, as seen in the above chart. This is a

Kapha dosha manifestation. Kapha dosha is made of earth and water. It is heavy, stable and

fluid. It creates ojas which is our immune function, as well as mental and physical stability. It is

the force that enables us to withstand stress and enables compassion and abundant love.

During menopause, the mobile quality of vata has the potential to push kapha out of balance

creating more heavy quality in women, resulting in weight gain.

The Caraka Samhita wisely said, “it is lack of equilibrium in the three Doshas that creates

disease and equilibrium that causes health.25 We see the wisdom of Ayurvedic philosophy.

Rather than treating symptoms, Ayurveda treats the starting point of disease by looking at the

doshas that are out of balance and working to bring them back into balance. Symptoms are the

body’s way of communicating underlying imbalances. Vata dosha is the precipitating force

behind menopausal distress. Management of Vata is the first line of treatment for relief and

improved quality of life during this time of life.

WESTERN TREATMENT APPROACH

According to Claudia Welch “Between the 1960’s and 2002, it had become standard practice to

prescribe HRT to menopausal women. Women loved what they did for their hot flashes and

their skin.”26 Hormone replacement therapy was among the leading forms of treatment in

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Western medicine for many years. It is still common practice and includes varying forms of

hormones such as estrogens, progestins, androgens, and tibolone. Anti-depressants (SSRI’s)

are also prescribed. Phytoestrogens are also now part of the treatment conversation.

According to the Mayo Clinic, Hormone replacement therapy is medication that contains female

hormones. The medication is taken to replace estrogen (and other hormones) the body stops

making during menopause. This therapy is used to prevent bone loss, reduce fractures,

alleviate hot flashes, night sweats, vaginal dryness, itching, and burning, among others.27 The

below chart reflects a recommended Western approach for treating a woman in menopause:

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Hormone therapy is currently the most common form of treatment for menopause in

conventional medicine. According to Heidi Nelson “estrogen is the most consistently effective

therapy for vasomotor symptoms and demonstrates benefit in most trials evaluating urogenital

symptoms. Some, but not all trials evaluating sleep, mood and depression, sexual function, and

quality of life outcomes also report benefit with estrogen compared to placebo.”29 Estrogen

therapy has proven to be effective in providing relief from multiple discomforts associated with

menopause. Treatment with progestins, testosterone, testosterone combined with estrogen had

mixed results or showed some improvement in symptoms.30 Obviously the use of hormones

replacement provides relief from menopausal symptoms. Furthermore, SSRI’s (selective

serotonin reuptake inhibitors) are more frequently prescribed now as an alternative to hormone

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therapy for hot flashes.31 The ability to find relief from menopausal symptoms through hormone

replacement or SSRI medications might lead us to conclude that it is an obvious choice for the

management of menopausal symptoms.

However, this does not come without a price. Side effects may arise when taking synthetic

hormones. They include the potential for breast tenderness, uterine bleeding, nausea, vomiting,

headache, weight changes, dizziness, venous thromboembolic events, cardiovascular events,

rashes, cholecystitis and liver effects.32 With SSRI’s women may experience nausea,

headaches, and dizziness, although these symptoms are not as common due to low dosing.

Side effects that arise often subside after a few weeks of starting treatment.

In her book, Claudia Welch discusses the halt of a large scale hormone replacement therapy

study because of an alarming increase in breast cancer in its participants. The same study

demonstrated that these same women were at higher risk for strokes, heart attacks, dementia,

and alzheimer’s disease.33 Despite these studies, synthetic hormones are still an available

option for women entering peri-menopause and later menopause. Recommendations are given

based on the risk profile of an individual to develop further complications as a result of hormone

therapy.34 Those who choose hormone replacement do so as a means of improving their

quality of life. Some have severe symptoms or simply do not want to live their lives with the

ailments that come with menopause. Others may not be aware of or feel uncomfortable with

potential side effects or known risks of hormone therapy. Moreover, the data is mixed when it

comes to the risks vs. benefits regarding hormone therapy. This makes the decision all the

more confusing and difficult for women when faced with issues that affect their quality of life.

The choice is currently left to each individual with the guidance of a medical practitioner.

Western medicine can serve as a beneficial complement to a natural and holistic path. It can be

used as an interim mechanism for achieving relief from acute symptoms that have a significant

impact on one’s life. Ayurveda takes a longer-term approach to the treatment of menopause. In

fact, Ayurveda’s recommendations start years before the first signs of menopause even first

start to appear.

AYURVEDIC MANAGEMENT

Ayurveda is the science of life. Its emphasis is on achieving optimal health which allows for a

higher quality of life and greater connection to spirit. It is a holistic approach that looks at all

aspects of well-being and dis-ease as a means of creating a lifelong plan for balance. In Dr.

Welch’s book, she describes a typical holistic approach to regaining health. This includes

making “appropriate diet, lifestyle and stress reduction changes first. Use of natural herbs and

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remedies when extra support is needed. Use surgery, pharmaceutical or bioidentical drugs in

an emergency, as a stopgap measure when physical, mental, or emotional symptoms are

unbearable or to manage such symptoms when first-tier and second-tier strategies are

insufficient.”35 With this in mind, how do we apply these principles to an Ayurvedic treatment

plan for menopause?

As previously discussed, menopause takes place during the Vata time of life. Furthermore,

imbalances and symptoms experienced during menopause are most often caused by Vata

dosha. Consequently, treatments will be primarily geared towards pacifying Vata dosha.

Ayurveda has a wide variety of tools and treatments for restoring balance during this time of life.

DIET

What we eat and whether we can digest is at the forefront of Ayurvedic medicine. According to

Dr. Marc Halpern “the digestive system is the physical root of most diseases in the body.”36 Our

food has the potential to be a medicine when it is appropriate for the person consuming it and

they can digest it. However, when we eat out of alignment with our constitution, season and

time of life, this same food negatively affects our health.

VATA DIET:

A Vata pacifying diet includes an emphasis on the “sweet taste as it is tonic and helps to

support all of the dhatus and ojas. Tonic therapy at this time of life slows the rate of depletion

allowing a gradual transition to take place.37 The Ayurvedic sweet taste includes foods that

nourish. It is not sweet foods in the western sense such as cookies, cakes, and candies.

Rather, it includes foods such as meats, animal protein, milk, nuts and seeds, whole grains,

healthy oils and ghee. All of these foods build bodily tissues and balance the natural depletion

taking place in the body. According to an article in the International Ayurvedic Journal, “Ghee

has a special role in improving sukra dhatu. Ghee is now considered to be a good source of

omega -3 fatty acids.”38 Shukra dhatu is our reproductive tissue. It is the last to gain nutrition

from the food we eat. It is also the tissue that becomes depleted during menopause, which we

see as declining reproductive hormones. Ghee is one of the most coveted foods for managing

Vata dosha and is therefore an optimal food to consume during menopause.

Furthermore, to balance Vata’s naturally cold, light and dry qualities, a diet of warm, cooked, oily

foods, and well spiced food is most suitable. This can include warm, cooked grains like

oatmeal, soups and stews served warm with added fats such as olive oil, whole avocados

and/or nuts and seeds eaten on a regular basis. Spices such as fennel and cumin (among

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others), which are not overly heating (which can cause further drying to the body) are

recommended. It is important to note with all of the above that foods eaten should be fresh and

not processed, frozen, or canned.

In contrast, foods that are cold, light and dry such as ice and cold drinks, smoothies, crackers

and chips, raw foods and salads attract like qualities to Vata dosha. This in turn will further

aggravate the body during menopause. The sour and salty tastes are also balancing for Vata

dosha. According to John Immel from Joyful Belly, Salty taste “stimulates secretions, thus

improving digestion. Salt is a laxative, breaking up all hard masses in the digestive tract.”39

Furthermore, sour taste “pacifies Vata. Sours are secretagogues. They moisten and refresh a

dry palate, encouraging secretions throughout the GI tract. These might be salivary secretions

that improve taste, gastric secretions in the stomach that improve digestion, or a moist colon

that facilitates smoother, looser bowel movements.”40 Both sour and salty tastes further support

balancing Vata dosha and are recommended, second to sweet taste during the menopausal

time of life. Eliminating alcohol, caffeine, and refined sugar are additional components of

managing menopause for all women.

PITTA DIET:

It is important to take a comprehensive approach and account for other doshas at play when

treating menopausal symptoms. Clients experiencing Pitta anger still benefit from the sweet

taste. However, some modifications are necessary such as the reduction in the sour and salty

tastes. Both increase heat, fire and pitta dosha as a whole. With pitta dosha, the optimal diet

includes an “increase in cooling foods, high water intake, sweet juicy fruits (grapes, pears,

plums, mango, melons, apples), zucchini, yellow squash, cucumber, and organic foods. Use of

spices such as cinnamon, cardamom and fennel. Avoid hot spicy foods, hot drinks and

alcohol.”41 The primary goal and difference with balancing pitta during menopause is reducing

heat by bringing in cooling foods and substances. This balances the heat in the mind that leads

to anger and the drying effects of excess heat in the body.

KAPHA DIET:

Finally, Kapha dosha predominant women may experience weight gain, lethargy and

melancholy. They are the least likely to experience many of the other symptoms of

menopause.42 Due to its heavy, stable, and moist qualities, women of this constitution suffer the

least during menopause. The qualities of Kapha are opposite those of Vata and menopause.

This leads to less depletion and symptoms as a whole.

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The most appropriate diet is filled with warm, spicy foods that increase digestive strength and

improve digestion as a whole. Sweet, nourishing foods prepared with warming spices should be

taken in small quantities on a regular basis. Small quantities of nourishing foods taken 3-5X per

day.”43 Kapha women going through menopause still have a vata influence in the body.

Nourishing foods (the sweet taste) is still the emphasis of the recommended diet. However,

smaller portions in more frequent amounts, with warming spices will improve digestion and

balance the weight gain that can happen for kapha women at this time of life.

LIFESTYLE

Lifestyle practices are equally important in managing Vata dosha and its contribution to

menopausal symptoms. Vata dosha benefits from a regular eating schedule, early bedtime,

meditation, yoga, and gentle, regular exercise like walking and oil massage (abhyanga) using

almond and olive oil.44 Once again, we see the importance of adding nourishment to the body.

Nourishing practices combat the light, cold and dry qualities of Vata by bringing in oils which are

warm, heavy and moistening to the body both externally and internally as they sit and penetrate

the skin. An early bedtime supports rest, rejuvenation and nourishment of the mind, as well as

detoxification that takes place during sleep.

According to Gupta Payal, “Yoga Therapy is a useful adjunctive complementary & integrative for

menopausal women. Current evidence indicates that women will benefit from yoga therapy

during menopausal transition in term of decrease risk of cardiovascular disease, insulin

resistance & loss of bone mineral density as well as improved psychological well-being, sleep

patterns & emotional modulation.”45 Yoga is an integral part of an Ayurvedic treatment plan for

menopause. It is not overly depleting or draining. It provides weight bearing physical activity

which is critical for managing osteoporosis. Still, it is not overly straining. It also aids in mental

well-being as can meditation in addition to connecting to one’s spiritual potential during this

phase of life.

PITTA AND KAPHA LIFESTYLE:

Pitta and kapha dosha will also benefit from the above lifestyle recommendations during

menopause with some slight modifications. Those experiencing Pitta type menopausal

symptoms benefit from the additional of coconut oil during self-massage. Meditation is

encouraged for managing anger. Exercise and sun exposure are limited.46 Due to the hot

nature of Pitta dosha anything that creates heat in the body is discouraged. This also includes

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over exercising. Working out during the hot parts of the day, heated emotions, over working and

competitive behavior. In general, cooling lifestyle practices are encouraged.

Kapha dosha is advised to “get up early. Mustard oil and linseed oil are often recommended for

massage.”47 These recommendations are aligned with general practices for managing the

heavy, cold qualities of kapha dosha.

In summary, diet and lifestyle modifications have the ability to transform our health. It is often

these factors themselves that initially brought imbalance into our lives. So too, can change in

these areas of our lives that can initiate healing. However, once disease has set in, especially

during menopause, it is often many years after the imbalance originally began. Diet and lifestyle

modifications may no longer be sufficient for overcoming menopausal ailments. This is when

Ayurveda makes further recommendations to add herbal treatments.

HERBAL TREATMENT

When diet and lifestyle do not provide sufficient relief from menopausal symptoms, women can

turn to herbs for additional support. In her book Menopausal Years, The Wise Woman Way,

Susan Weed says plant medicine “provide[s] hormonal building blocks, rather than hormones

themselves, thus allowing you to create the precise amounts (and combinations) of hormones

needed on your unique menopausal journey…the body in her wisdom can create the hormones

she needs from the building blocks supplied by the plant.”48 Herbs can be a powerful ally in the

journey through menopause. They provide symptomatic relief and also support treatment of

accumulated long-term underlying imbalances.

VATA:

Herbs that elicit estrogenic effects in the body are most commonly used to treat menopause.

They are called reproductive tonics. The primary herbs include motherwort, red clover and saw

palmetto. Dong quai, vitex, blue and black cohosh, wild yam and licorice are also used, but are

slightly weaker. Shatavari is the most commonly used herb in India.49 These herbs are

inherently nourishing/moistening and are reproductive tonics. They are also used to provide

relief from vaginal dryness and hot flashes.50 Additional herbs recommended during menopause

include Ashwagandha (as a long term adaptogen), Arjuna (as a cardiac tonic), Cardamom (as a

digestive to help the body digest other heavier herbs), Garlic (as a warming anti-microbial ), and

Guggul (as an anti-inflammatory, blood tonic and vasodilator).51 Ideally, women seeking holistic

management of symptoms would take a custom tailored formula created for their unique needs

by an experienced Ayurvedic practitioner.

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PITTA:

As typical in Ayurvedic medicine, each woman is unique and treatments will vary from one

person to the next. Women with a Pitta constitution or experiencing pitta type menopausal

symptoms will benefit from the addition of cooling herbs. Cooling dipanas (digestion supporting

herbs) such as fennel, coriander, cumin, peppermint and chamomile are recommended.

According to Dr. Marc Halpern, “one of the best herbs to use is Shatavari.”52 Shatavari is

cooling in nature. It is an antacid, a nutritive, a tonic, a refrigerant, anti-inflammatory, anti-

microbial, a uterine and muscle tonic, and soothes burning53 (a common symptom of

imbalanced Pitta dosha). Shatavari is one of the best herbs to support women experiencing

pitta type menopausal symptoms. For treatment of the mind and pitta type anger and emotional

imbalance, Brahmi and shanka pushpi are recommended.54 These are valuable herbs in

treating Pitta imbalanced menopause when emotional instability can wreak havoc on a woman’s

emotional state.

KAPHA:

Women with a kapa constitution will often experience the slowing of digestion during

menopause. Therefore, digestion is a primary focus of treatment. Warming spices and dipanas

such as trikatu (ginger, black pepper, long pepper) is a valuable digestive aid and can be added

to meals. Another class of herbs that are recommended are lekhanas such as guggul and

chitrak, as well as trikatu.55 These are channel clearing and aid in weight-loss. According to

Gupta Payal, additional kapha supporting herbs for kapha type menopause include cinnamon,

mustard, Haritki and nagarmotha.56 All of these herbs counteract the typical possible

imbalances of women with a kapha nature that may be pushed even further out of balance

during menopause.

In her book, Claudia Welch cautions that “herbal remedies are a stopgap measure until life has

been balanced long enough to have regained hormonal balance…this is easier said than done.

Sometimes herbs are used for a long time or indefinitely if a woman’s history of imbalance is

severe, long standing or both and her symptoms have progressed beyond the ability of lifestyle

and diet alone to manage.57 Herbal support can be an ally in the treatment of menopause.

Ideally, one should not rely on it as a crutch to avoid diet and lifestyle correction. The latter can

bring about long term mental and physical wellness and prevent the further deterioration of

health.

PHYTOESTROGENIC FOODS

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According to Dr. Marc Halpern, Phytoestrogens are plant-based chemicals that mimic the

effects of estrogen and sometimes progesterone in the body.58 Phytoestrogens can be found in

many common foods such as some legumes, seeds, nuts, grains, dairy, soy, flaxseeds and

even alcohol. Unfortunately, the evidence is inconclusive regarding the benefits of consuming

these types of foods for relief of menopausal symptoms. Some studies have shown health

benefits with respect to menopause in lowering LDL cholesterol, lowered risk of osteoporosis

heart disease, breast cancer and menopausal symptoms as a whole.59 Some studies found that

phytoestrogen supplementation during menopause provides similar symptomatic relief to that of

women taking estrogen supplementation.60

Despite the research showing phyto-estrogenic foods provide benefits to menopausal women,

there are simultaneous studies that show the exact opposite. There is some data that

demonstrates breast cancer and infertility risks.61 In an article by Heather Patisaul, she cites that

“phytoestrogens, particularly the isoflavones, fit the Environmental Protection Agency’s

definition of an endocrine disruptor which characterizes these compounds as those which, “alter

the structure or function(s) of the endocrine system and cause adverse effects.” This definition

includes disruption of lactation, the timing of puberty, the ability to produce viable, fertile

offspring, sex specific behavior, premature reproductive senescence and compromised

fertility.”62 The below chart shows some of the pros and cons associated with consumption of

phyto-estrogic foods. It demonstrates the existence of evidence in support of and against their

use.

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63

Similar to bio-identical and traditional hormone replacement therapy, the data provides mixed

results. Some of this is attributable to variations in dose, dietary composition, phytoestrogens

administered, the duration of use from one study to the next, sample sizes of feeding trials, and

studies being funded by soy companies which creates mistrust in the results.64 As a result of

variable results, moderation is likely key for maximizing benefits.

CONCLUSION

It is projected that 103 million women will be going through or be in menopause by the year

2026. 85% will experience one or more symptom.65 Many will be plagued with the choice to live

with uncomfortable symptom or take hormones replacement therapy. Some will suffer with

either choice they make. Ayurveda offers tangible answers and solutions to improve quality of

life during menopause. Women’s health has generally been equated with reproduction. Due to

the increase in lifespan and the continued productivity of women, a new lens for looking at

additional areas of women’s health is warranted. The earlier we awaken conversation regarding

this inevitable transition in women’s lives, the sooner women can begin to properly prepare their

bodies for menopause. Earlier education on this topic is an opportunity to identify and prevent

chronic diseases later in life. It opens opportunities for women to achieve a higher quality of

living in their later years to enjoy the expansive nature of this time of life.

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REFERENCES

 1 Report of WHO. Scientific Group Research on Menopause. WHO technical report series 670. Geneva, World Health Organization, 1981. 2 Pro. K.R. Srikantha Murthy, Astanga Hrdayam Vol 1, (Government College of Indian Medicine, Bangalore, Krishnadas Academy, Varanasi, 1995), Section 2, Verse 21b‐22a page 363 3 Welch, C. (2011). Balance Your Hormones, Balance Your Life: Achieving Optimal Health and Wellness through Ayurveda, 

Chinese Medicine, and Western Science (1st ed.). Da Capo Lifelong Books. 4 OlaOlorun, F., & Shen, W.  (2020, November 19). Menopause. Oxford Research Encyclopedia of Global Public  

Health. Retrieved 21 Dec. 2020, from  https://oxfordre.com/publichealth/view/10.1093/acrefore/9780190632366.001.0001/acrefore‐9780190632366‐e‐176  

5 Makara‐Studzinska, Marta Teresa, et al. Epidemiology of the Symptoms of Menopause – an Intercontinental Review. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4520365/pdf/MR‐13‐23066.pdf.  

6 Ibid (page 5‐94). 7 Ibid  8 OlaOlorun, F., & Shen, W. , Menopause. Page 2.  9 Dr. Marc Halpern, Textbook of Clinical Ayurvedic Medicine (Eighth Edition), Vol. 1 (California College of Ayurveda, 2020), Page 5‐95.  10 OlaOlorun, F., & Shen, W. , Menopause. Page 2. 11 Monteleone, P., Mascagni, G., Giannini, A. et al. Symptoms of menopause — global prevalence, physiology and implications. Nat Rev Endocrinol 14, 199–215 (2018). Retrieved from https://www.nature.com/articles/nrendo.2017.180  12 Halpern, Clinical Ayurvedic Medicine, (page 5‐95). 13 Prof. Baranwal, V. (2015, June).  Beyond HRT – Ayurveda and Menopause and Associated Aging Problems.  International Journal of Medicinal Palnts and Natural Products. Retrieved December 23, 2020 from [https://www.researchgate.net/publication/318041856_Beyond_HRT‐Ayurveda_for_Menopause_and_Associated_Aging_Problems ] 14 OlaOlorun, F., & Shen, W. , Menopause. Page 15. 15 Professor Srikantha Murthy K.R. 2nd Edi. Sushrut Samhita vol‐1, Shareer Sthan, Chapter 3, Verse 11, Varanasi, Chaukamba, 2004, Page 37.  16 Shastri A D, Sushrut Samhita of Maharishi Shusruta with Ayurvedatatvasandipika Hindi commentary, Sutra Sthan, Cpater 35, Verse 36, Chaukhambha Sanskrit.  17 Immel, John. Catabolic Body Type (Vata Dosha), accessed December 21, 2020 at { https://www.joyfulbelly.com/Ayurveda/article/Vata‐Dosha/63}.  18 CCA Staff.  California College of Ayurveda, March 11, 2013 accessed January 5, 2020 at [https://www.ayurvedacollege.com/blog/vata‐dosha‐ayurvedic‐medicine]  19 Halpern, Clinical Ayurvedic Medicine, Page 5‐94.  20 Ibid.  21 Ibid.  22 Srikantha Murthy, Prof. K. R. Astanga Hrdayam; Varanasi India. Krishnadas Academy, Fourth 1999 23 Nidanasthana; Vatavyadhinidana: Chapter 15, Verse 1‐3, 276. 24 Welch, Claudia. Balance Your Hormones, Balance Your Life. Page 117.  25 Sharma RK, Bhagwan Dash V, editors. Varanasi: Chowkhamba Sanskrit Series Office; 2008. Agnivesha, Dridhabala, Charaka. Charaka Samhita, Sutra Sthana. Vol. 1. Atreyabhadrakapiya Adhyaya, 26/27; p. 454. Reprint ed. [Google Scholar] 26 Welch, Claudia. Balance Your Hormones, Balance Your Life. Page 34.  27 Mayo Clinic. “Hormone therapy: Is it right for you?“ Mayo Clinic. June 9, 2020. Accessed December 23, 2020 at [https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/ART-20046372]. 28 Kaunitz A.M., Manson JE. Management of Menopausal Symptoms. Obstet Gynecol. 2015 Oct;126(4):859‐76. doi: 10.1097/AOG.0000000000001058. PMID: 26348174; PMCID: PMC4594172 . 29 Nelson HD. Menopause. Lancet. 2008 Mar 1;371(9614):760‐70. doi: 10.1016/S0140‐6736(08)60346‐3. PMID: 18313505. 30 Ibid.  

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 31 Kaunitz A.M., Manson JE. Management of Menopausal Symptoms. Page 10. 32 Ibid.  33 Welch, Claudia. Balance Your Hormones, Balance Your Life. Page 35.  34 Kaunitz A.M., Manson JE. Management of Menopausal Symptoms. Page 8. 35 Ibid. Page 42.  36 Halpern, Marc.  Healthy Digestion – Healthy Body, accessed December 22, 2020 at {https://www.ayurvedacollege.com/blog/healthydigestion/}     37 Halpern, Marc.  Clinical Ayurvedic Medicine.  Page 5‐98.  38 Shirshetty, J., Swamy, S., Bhadre, D., Hadimani, R. and Chauhan, S., 2020. Rajonvritti (Menopause) An Ayurvedic Perspective. [online] Iamj.in. Available at: <http://www.iamj.in/images/upload/2496_2501.pdf  [Accessed 23 December 2020].  39 Immel, John.  The Six Tastes: Salty, accessed December 22, 2020 at { https://www.joyfulbelly.com/Ayurveda/herbal‐action/Salty}  40 Immel, John. The Six Tastes: Sour, accessed December 22, 2020 at { https://www.joyfulbelly.com/Ayurveda/herbal‐action/Sour}  41 Payal, G., Kumar, M. P., Indumati, S., & Anamika, S. (2016, February). AYURVEDIC APPROACH FOR A GRACEFUL MENOPAUSE –A REVIEW ARTICLE. International Ayurvedic Medical Journal, Volume 4(Issue 02), 3–4. http://www.iamj.in/posts/2016/images/upload/243_248.pdf_corrected.pdf  42 Halpern, Marc. Clinical Ayurvedic Medicine. Page 5. 99.  43 Ibid.  44 Gupta, P.  Ayurvedic Approach for a Graceful Menopause. Pages 3–4. http://www.iamj.in/posts/2016/images/upload/243_248.pdf_corrected.pdf  45 Ibid.  46 Ibid.  47 Ibid.  48 Weed, S., 1992. Menopausal Years. Woodstock, N.Y.: Ash Tree Pub. Page 43.  49 Halpern, Clinical Ayurvedic Medicine. Page 5‐98.  50 Ibid.  51 Gupta. P. Ayurvedic Approach for a Graceful Menopause. Pages 3‐4.  52 Halpern, Marc. Clinical Ayurvedic Medicine. Page 5‐99.  53 Immel, John. Shatavari, accessed December 24, 2020 at [https://www.joyfulbelly.com/Ayurveda/product/Shatavari/79]  54 Halper, Marc. Clinical Ayurvedic Medicine. Page 5‐99. 55 Ibid. Page 5‐100.   56 Gupta, P. Ayurvedic Approach for a Graceful Menopause. Page 3‐4.  57 Welch, Balance Your Hormones, Balance Your Life, page 264.  58 Halpern, Marc. Clinical Ayurvedic Medicine. Page 5‐117. 59 Patisaul HB, Jefferson W. The pros and cons of phytoestrogens. Front Neuroendocrinol. 2010 Oct;31(4):400-19. doi: 10.1016/j.yfrne.2010.03.003. Epub 2010 Mar 27. PMID: 20347861; PMCID: PMC3074428. 60 Ibid, pg 5‐119. 61 Ibid, pg 5‐119‐120. 62 Patisaul, Jefferson. The pros and cons of phytoestrogens. Pg. 4. 63 Patisaul, Jefferson. The pros and cons of phytoestrogens.  64 Ibid. 65 Prof. Baranwal, V. Beyond HRT – Ayurveda and Menopause and Associated Aging Problems.   

         

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ABSTRACTS  Balance Your Hormones, Balance Your Life:

This book Combines Eastern medical theory with Western science to provide uncommon insights into hormones, women’s health concerns, lifestyle and diet. It goes well with Women’s Health & Hormones, Part I: Hormonal Balance & Stagnation–our online course that is really meant to go with this book, nice dark chocolate and goblet of grape juice.

Experience of menopausal symptoms by women in an urban community in Ibadan, Nigeria Funmilola M Olaolorun, Taiwo O Lawoyin

Menopause is the natural senescence of ovarian hormonal production, and it eventually occurs in every woman. The age at which menopause occurs varies between cultures and ethnicities. Menopause can also be the result of medical or surgical interventions, in which case it can occur at a much younger age. Primary symptoms, as well as attitudes toward menopause, also vary between cultures. Presently, the gold standard for treatment of menopause symptoms is hormone therapy; however, many other options have also been shown to be efficacious, and active research is ongoing to develop better and safer treatments.

In a high-resource setting, the sequelae/physiologic changes associated with menopause can impact a woman’s physical and mental health for the rest of her life. In addition to “hot flashes,” other less well-known conditions include heart disease, osteoporosis, metabolic syndrome, depression, and cognitive decline. In the United States, cardiac disease is the leading cause of mortality in women over the age of 65. The growing understanding of the physiology of menopause is beginning to inform strategies either to prevent or to attenuate these common health conditions. As the baby boomers age, the distribution of age cohorts will increase the burden of disease toward post-reproductive women. In addition to providing appropriate medical care, public health efforts must focus on this population due to the financial impact of this age cohort of women.

Epidemiology of the symptoms of menopause – an intercontinental review

Marta Teresa Makara-Studzińśka, Karolina Maria Kryś-Noszczyk, and Grzegorz Jakiel

The age of menopause is a time of many changes in the psychophysical-social functioning of women, with reduced ovarian hormonal activity and estrogen levels. The most common, troublesome symptoms of menopause age include depressive disorders, sleep disorders, sexual dysfunction, discomfort associated with muscle pain, joint aches, osteoporosis and characteristic hot flashes.

Aim of the study

Aim of the study is to determine and compare the rate of menopausal symptoms among women living in continents of both Americas, Africa, Australia and Eurasia.

Material and methods

The results of this work were obtained in 2014 on the basis of the data from a review of the 64 most important studies using the PubMed database. Research published in the period 2000-2014, from Africa, both Americas, Australia and Eurasia, were taken into account.

Results

The prevalence of menopausal symptoms in African women is disconcertingly high. Women from South America complain about occurrence of depressive, sexual dysfunctions and discomfort associated with muscle pain and joint aches. Symptoms most reported by women in the United States are pains

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 associated with muscles and joints. Women in Australia suffer mainly due to vasomotor symptoms and sexual dysfunction, while in the group of women surveyed in Asia there is observed an alarming increase in the proportion of women reporting depressive disorders. In Europe there was a much greater incidence of sleep disorders and depressive disorders.

Menopause: Hormones, Lifestyle, and Optimizing Aging Mary Jane Minkin

Although American women spend approximately 30% to 40% of their lives in menopause, a state defined by the cessation of estrogen production by the ovaries, obstetricians and gynecologists in North America receive little formal education about menopausal health. Hormonal therapy has been available for more than 75 years; however, controversies surrounding its use have impacted training of care providers in all specialties. This article offers updates on care for menopausal women, focusing on symptomatology and health issues that arise related to the decline in all reproductive hormones. Lifestyle adaptations and nonmedical approaches, and nonhormonal and hormonal medications are discussed.

Beyond HRT-Ayurveda for Menopause and Associated Aging Problems Professor Baranwal

The physiological function of most organ systems tends to decline with age, but there is a wide individual variability. Every person deserves precise diagnosis and assessment of function together with individually tailored management. The climacteric is a critical period in women’s life where loss of ovarian follicular activity is characterized biologically by decline in fertility, endocrinologically by alteration of hormone levels, and clinically by variation in menstrual cycle length and experience of a variety of symptoms. For decades, estrogen, either alone or in combination with progestins (HRT) has been the therapy of choice. The results of two large studies on HRT, The Heart and Estrogen/progestin Replacement Study (HERS) (1) and the Women's Health Initiative (WHI) Study (2) however, have modified the risk/benefit perception of HRT. Search for safe alternatives other than HRT to provide optimum physical and mental fitness are warranted. This review puts together probable cause and therapeutics based on Ayurvedic principals. It also lists the group of drugs that can be used in aging population to alleviate menopausal as well as associated aging problems, tailored according to the individual needs.

AYURVEDIC APPROACH FOR A GRACEFUL MENOPAUSE –A REVIEW ARTICLE 

Gupta Payal, Mishra Pramod Kumar, Sharma Indumati, Soni Anamika 

Menopause is defined as absence of Menstrual period for 12 months. There is no reliable lab test to predict when a woman will experience menopause. In India Average age of Menopause in around 48 years but it strikes Indian women as young as 30-35 years. So menopausal health demands even higher priority in Indian scenario. The term Rajonivritti means "End of ArtavaPravritti" or Cessation of menstruation as well as ovarian function. Rajonivrittti as a diseased condition is not described separately in the classics; Rajonivritti-kala is mentioned by almost all Acharyas. Due to changing lifestyle, food habits and socio-economic standards the age is decreasing. By taking into consideration all the references available in Ayurveda classics, efforts have been made to review critically the said subject in the light of Menopausal Syndrome mentioned in modern Medicine as the fundamentals of Ayurveda in this paper.

Management of Menopausal Symptoms Andrew M Kaunitz , JoAnn E Manson

Most menopausal women experience vasomotor symptoms, with bothersome symptoms often lasting longer than one decade. Hormone therapy (HT) represents the most effective treatment for these symptoms, with oral and transdermal estrogen formulations having comparable efficacy. Findings from the Women’s Health Initiative and other recent randomized clinical trials have helped to clarify the benefits and risks of combination estrogen-progestin and estrogen-alone therapy. Absolute risks

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 observed with HT tended to be small, especially in younger women. Neither regimen affected all-cause mortality rates. Given the lower rates of adverse events on HT among women close to menopause onset and at lower baseline risk of cardiovascular disease, risk stratification and personalized risk assessment appears to represent a sound strategy for optimizing the benefit: risk profile and safety of hormone therapy. Systemic HT should not be arbitrarily stopped at age 65; instead treatment duration should be individualized based on patients’ risk profiles and personal preferences. Genitourinary syndrome of menopause represents a common condition that adversely impacts the quality of life of many menopausal women. Without treatment, symptoms worsen over time. Low-dose vaginal estrogen represents highly effective treatment for this condition. Because custom-compounded hormones have not been tested for efficacy or safety, U.S. Food and Drug Administration (FDA)-approved HT is preferred. A low dose formulation of paroxetine mesylate currently represents the only nonhormonal medication FDA-approved to treat vasomotor symptoms. Gynecologists and other clinicians who remain abreast of data addressing the benefit: risk profile of hormonal and nonhormonal treatments can help menopausal women make sound choices regarding management of menopausal symptoms.

Menopause Heidi D Nelson

Menopause is the time of life when menstrual cycles cease, and is caused by reduced secretion of the ovarian hormones oestrogen and progesterone. Although menopause is a normal event for women, individual experiences vary, and some women seek medical advice for the management of symptoms. Many symptoms have been attributed to menopause, but only vasomotor dysfunction and vaginal dryness are consistently associated with this time of life in epidemiological studies. Other common symptoms such as mood changes, sleep disturbances, urinary incontinence, cognitive changes, somatic complaints, sexual dysfunction, and reduced quality of life may be secondary to other symptoms, or related to other causes. Trials of therapies for vasomotor dysfunction have shown improvements with oestrogen, gabapentin, paroxetine, and clonidine, but little or no benefit with other agents; adverse effects of these treatments must also be considered. Many questions about menopausal transition and its effects on health have not been adequately addressed.

The pros and cons of phytoestrogens Heather B Patisaul 1, Wendy Jefferson

Phytoestrogens are plant derived compounds found in a wide variety of foods, most notably soy. A litany of health benefits including a lowered risk of osteoporosis, heart disease, breast cancer, and menopausal symptoms, are frequently attributed to phytoestrogens but many are also considered endocrine disruptors, indicating that they have the potential to cause adverse health effects as well. Consequently, the question of whether or not phytoestrogens are beneficial or harmful to human health remains unresolved. The answer is likely complex and may depend on age, health status, and even the presence or absence of specific gut microflora. Clarity on this issue is needed because global consumption is rapidly increasing. Phytoestrogens are present in numerous dietary supplements and widely marketed as a natural alternative to estrogen replacement therapy. Soy infant formula now constitutes up to a third of the US market, and soy protein is now added to many processed foods. As weak estrogen agonists/antagonists with molecular and cellular properties similar to synthetic endocrine disruptors such as Bisphenol A (BPA), the phytoestrogens provide a useful model to comprehensively investigate the biological impact of endocrine disruptors in general. This review weighs the evidence for and against the purported health benefits and adverse effects of phytoestrogens.